Healthcare Provider Details

I. General information

NPI: 1205800703
Provider Name (Legal Business Name): JAMES J OCONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20408 ROCKAWAY POINT BLVD
ROCKAWAY POINT NY
11697-1115
US

IV. Provider business mailing address

20408 ROCKAWAY POINT BLVD
ROCKAWAY POINT NY
11697-1115
US

V. Phone/Fax

Practice location:
  • Phone: 718-474-5454
  • Fax: 718-634-4248
Mailing address:
  • Phone: 718-474-5454
  • Fax: 718-634-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number145779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: